A randomized controlled trial of the efficacy of a multifaceted counseling and support intervention for spouse caregivers of Alzheimer's disease (AD) patients began at the NYU Silberstein Aging and Dementia Research Center (NYU-ADRC) in 1987. A sample of 406 spouse-caregivers (162 husbands and 244 wives) was assigned to either the intervention or a usual care control condition. All caregivers are regularly evaluated through home caregiving, nursing home placement, and post-bereavement phases of the caregiving career. The project has been highly successful in recruiting and retaining study subjects, and in demonstrating the powerful impact of the intervention in producing sustained reductions in caregiver depression, improved appraisals, and reduction of nursing home placement. Most caregivers have now passed through at least one major transition - nursing home placement or death of the patient and profound changes in dementia severity. This study is generating a unique longitudinal database with a large sample and many years of data that carefully track the emotional well-being, physical health, and social support resources of spouse-caregivers. We have now forged collaborations with experts in longitudinal caregiving research and transitions in caregiving, which have already resulted in several manuscripts providing additional evidence of the value of the intervention. Over the proposed three-year funding period, we will focus our efforts on an important and understudied problem which our group is uniquely capable of addressing: the impact of caregiver intervention in improving caregiver adaptation to the stressful transitional events of nursing home placement, bereavement, and progression of dementia. We will continue to use random effects growth curve modeling and structural equation modeling techniques to evaluate individual differences in caregiver functioning and adaptation to transitions (patient institutionalization and mortality or profound changes in severity of dementia), and to test for whether intervention improves adaptation to these stressful transitions. Major outcome variables include caregiver mental and physical health. Changes in social support are hypothesized to mediate the impact of the intervention condition on these outcome variables. Findings from this study will enable health professionals and policy makers to reduce the negative impact of AD on caregiving families and to enhance their understanding of the effects of caregiver intervention on stressful transitions.